Race just one factor among many in women’s missed cancer screenings

Women who miss cancer screenings face higher morbidity and mortality risks, and race may indicate who is more likely to get those screenings, according to a study presented at the North American Menopause Society Annual Meeting.

“This idea of racial disparities in health has gained a lot of traction and public attention in the last few years,” author Holly N. Thomas, MD, MS, assistant professor of medicine at the University of Pittsburgh, told Healio. “And I felt like, in particular, with regard to midlife and older women, perhaps we hadn’t had as much conversation about whether there might be racial or ethnic disparities and how we care for these women.”

Researchers surveyed 866 women (mean age, 43.5 years; 12% white, 36% Black, 49% Hispanic and 3% other races and ethnicities) in underserved areas of Chicago to evaluate the impact that race has on a woman’s likelihood to have a colonoscopy, mammogram or pap smear.

The researchers initially hypothesized that white women would be more likely to be screened for cancer than women from other racial and ethnic groups, but the cross-sectional survey revealed that this was not always the case.

For example, white women were more likely than Black and Hispanic women to have up-to-date colon cancer screenings in an unadjusted analysis. But these differences became statistically insignificant after adjusting for income, employment, education, disabilities, health insurance, age, BMI, comorbidities, smoking status and marital status.

However, Black women were more likely than white women to receive mammograms in multivariable analyses (adjusted OR = 4.91), according to the researchers.

Holly N. Thomas

“It was surprising to find that when we controlled for all those other factors, that within this particular population, Black women were more likely to have up-to-date cancer screenings compared to white women,” Thomas said.

In multivariable analyses, the researchers associated up-to-date colon cancer screenings with a lack of physical disability (OR = 3.22), a diagnosis of diabetes (OR = 3.1) and the patient having greater trust in their health care practitioner (OR = 2.24).

Similarly, factors associated with up-to-date mammograms included employer-based health insurance (OR = 3.21), a diagnosis of diabetes (OR = 4) and less reported racial discrimination from health care practitioners (OR = 10.81).

Up-to-date cervical cancer screenings were associated with a lack of physical disability (OR = 2.25) and a lack of history of hysterectomy (OR = 5.38).

Overall, approximately 80% of the study’s participants received a mammogram within the past 2 years, whereas 83% had a cervical cancer screening in the previous 5 years. Also, only 58% of women over the age of 50 years had up-to-date colon cancer screenings.

“And that’s only looking at women who should be getting colon cancer screenings,” Thomas said. “So as health care providers in a health system, we’re still not doing the best job of making sure that people get their colon cancer screening.”

Multiple obstacles may prevent women from accessing these screenings, Thomas said.

“To get a colonoscopy for colon cancer screening, patients need to have a means of transportation to get to the clinic to get it done. They have to have somebody who’s able to pick them up after the procedure. They have to be able to take the whole day off work to get it done,” Thomas said.

“You can imagine that if there are socioeconomic disparities between different racial groups that that could translate into more difficulty getting these types of cancer screenings done,” she continued.

Additionally, many women said they did not get these screenings because they were concerned about their costs, Thomas said, and some women were afraid that these tests might be painful or dangerous, particularly colon cancer screenings.

“It reinforces the importance of ensuring that our health care facilities and our screening tests are accessible to a wide range of individuals,” Thomas said.

Though the study included data from 2015 and 2016, Thomas said COVID-19 may have made many of these disparities worse.

“In my own practice, the pandemic has really had a negative effect on a lot of people’s abilities to keep up with their preventive care. Patients may be afraid to come into a health care facility to get their mammogram or to get their pap smear,” Thomas said, adding patients may have had changes in health insurance due to pandemic-related job loss or changes that affected their ability to get screenings.

“Low rates of cancer screenings were a problem before the pandemic and are even more of a problem now,” she said. “And of course, most of us fear that any racial or ethnic gaps in cancer screenings perhaps only got worse during the pandemic.”

Primary care providers should then take the lead in encouraging patients to get these types of exams, Thomas said.

“As a primary care provider with a trusting relationship with your patient, you can have a nuanced, honest conversation with the patient about what their fears are regarding that particular screening test and hopefully alleviate some of those fears and facilitate them getting their cancer screenings up to date,” she said.

Outside of the clinic, Thomas encourages clinicians to be at the forefront of working toward policy change so more patients have health insurance that covers these tests without any cost to them. Partnerships with social workers and community organizations also can facilitate screenings, such as with mobile mammogram services that provide breast cancer screenings.

With data from studies such as hers, Thomas said, the health care system can work toward eliminating these disparities and improving care.

“Knowing where the gaps lie in terms of cancer screenings can help health systems and health care providers and public health officials design programs that will really target the groups most in need to make sure that all women are getting these important screening tests,” Thomas said. “Now that we have a much better understanding of what are the factors that cause disparities in cancer screenings, we need to design and test interventions within health care systems to see what’s effective for actually increasing access to cancer screenings for vulnerable populations.”

Reference:

Thomas HN, et al. Racial differences in cancer screening among women. Presented at: North American Menopause Society Annual Meeting; Sept. 22-25, 2021; Washington, D.C.